On June 30, an ACNM-led coalition, the Coalition for Quality Maternity Care (CQMC) submitted commentsin response to the FY 2015 Inpatient Prospective Payment System (IPPS) proposed regulation. This regulation governs payment methodologies and policies under the Medicare program with regard to acute care hospitals. Within this very voluminous regulation, were proposals regarding four quality measures related to maternity care.

The first proposal was to include a quality measure related to the rate of elective deliveries prior to 39 weeks gestation without medical indication. The Centers for Medicare and Medicaid Services (CMS) has collected data on this measure for some time now, but has proposed to begin using hospital performance on this measure within the Hospital Value Based Payment program, meaning that how well they do on the measure would have a small impact on their reimbursement.

The second proposal was to include two new measures in the Inpatient Quality Reporting (IQR) program. Under this program, hospitals are required to report specified quality measures in order to receive a full update in their reimbursement, although their performance on the measures does not yet impact their reimbursement. The two measures of interest to ACNM were on related to exclusive breastfeeding during the hospital stay and on the proportion of newborns who did not experience unexpected complications.

The final comment in our letter was to encourage CMS in its stated goal to propose a measure of the rate of cesarean deliveries in each hospital for use in the IQR beginning in FY 2016 or 2017.

CMS will consider comments on their proposal and finalize their policies by August 1, 2014. They will apply to discharges occurring on or after October 1, 2014.

On June 30 the Supreme Court released a decisionin a case resolving a dispute between the federal government and employers who felt that a requirement that they use their employee health plan to cover contraceptives they perceived to be abortifacients violated their right to exercise their religious freedoms.

Both plaintiffs have indicated that they are comfortable offering insurance plans that cover most forms of contraception, but not those they perceive as endangering a fertilized egg.

Existing federal requirements would have subjected the employers to fines of many millions of dollars for failure to comply with the requirement.

By a 5-4 margin, the Court ruled in favor of the plaintiffs.

3. Veterans Administration Responds to ACNM Letter

On June 23, 2014, the Veterans Administration responded to a lettersent to them by ACNM in February of this year. f

In our letter, we expressed support for an expected change to the Nursing Handbook of the Veterans Health Administration that would provide for full practice authority for APRNs working in the VA system. We also explained the distinction between CNMs and CMs and advocated for inclusion of CMs in the list of providers allowed to care for the nation's veterans. Finally, we recommended that the VA consider employing CNMs full time, as they currently only contract with them for their services.

In its responseto ACNM, the VA indicated that it would be making a proposal to change the VHA Nursing Handbook and that this proposal would be open to public comment. Clearly, the VA intends to propose to allow APRNs to practice independently within VA facilities. They noted the distinction between CNMs and CMs, but stated that their concern at this time is with nurses. Finally, they noted that there are very few VA beneficiaries seeking obstetric care and so it has been their practice only to contract for the services of obstetric providers, rather than hire them full time.

HRSA maintains a database of areas and populations identified as experiencing shortages of these provider types and those shortage designation are used, among other things, to determine which facilities may accept participants in the National Health Service Corps (NHSC), or which physicians may receive the 10% bonus payment from Medicare.

HRSA staff have informed ACNM that loss of HPSA status should generally not impact a NHSC recipient's ability to continue working in the location where she has been placed.

To determine whether a location of facility has been determined to be located in a HPSA, visit HRSA's on-line database.

5. Recording of ACNM/NWLC Webinar on Breastfeeding and Contraception Coverage Now Available

On June 25, 2014, the National Women's Law Center (NWLC) and ACNM held a joint webinar during which experts from the NWLC discussed requirements for the coverage of breastfeeding supplies and equipment and contraceptive services, drugs and devices, as required under the ACA.

A recording of the webinar is now available. In addition, the slide can be downloaded. The NWLC has also made available a toolkit to help patients obtain coverage for breastfeeding supplies and equipment and another tookit to help them with preventive services, including contraception. A page with all of these items, and a few more, is available here.

Should you have questions about federal issues in any ACNM Policy Update, please contact Jesse Bushman, ACNM’s Director of Advocacy and Government Affairs at [email protected] or 240-485-1843.

Should you have questions about state issues in any ACNM Policy Update, please contact Cara Kinzelman, ACNM’s Manager of State Government Affairs at [email protected] or 240-485-1841.